TN 3 (10-99)

DI 34223.003 Respiratory Listings from 01/06/86 to 10/06/93

103.00 RESPIRATORY SYSTEM

1. A. 

   Documentation of pulmonary insufficiency. The reports of spirometric studies for evaluation under Table I must be expressed in liters (BTPS). The reported FEV₁ should represent the largest of at least three satisfactory attempts. The appropriately labeled spirometric tracing of three FEV maneuvers must be submitted with the report, showing distance per second on the abscissa and distance per liter on the ordinate. The unit distance for volume on the tracing should be at least 15 mm. per liter and the paper speed at least 20 mm. per second. The height of the individual without shoes must be recorded.

   The ventilatory function studies should not be performed during or soon after an acute episode or exacerbation of a respiratory illness. In the presence of acute bronchospasm, or where the FEV₁ is less than that stated in Table I, the studies should be repeated after the administration of a nebulized bronchodilator. If a bronchodilator was not used in such instances, the reason should be stated in the report.

   A statement should be made as to the child's ability to understand directions and to cooperate in performance of the test, and should include an evaluation of the child's effort. When tests cannot be performed or completed, the reason (such as a child's young age) should be stated in the report.

2. B. 

   Cystic fibrosis. This section discusses only the pulmonary manifestations of cystic fibrosis. Other manifestations, complications, or associated disease must be evaluated under the appropriate section.

   The diagnosis of cystic fibrosis will be based upon appropriate history, physical examination, and pertinent laboratory findings. Confirmation based upon elevated concentration of sodium or chloride in the sweat should be included, with indication of the technique used for collection and analysis.

103.01 CATEGORY OF IMPAIRMENTS, RESPIRATORY

103.03 Bronchial asthma. With evidence of progression of the disease despite therapy and documented by one of the following:

1. A. 

   Recent, recurrent intense asthmatic attacks requiring parenteral medication; or

2. B. 

   Persistent prolonged expiration with wheezing between acute attacks and radiographic findings of peribronchial disease.

103.13 Pulmonary manifestations of cystic fibrosis. With:

1. A. 

   FEV₁ equal to or less than the values specified in Table I (see 103.00A for requirements of ventilatory function testing); or

2. B. 

   For children where ventilatory function testing cannot be performed:

   1. 1. 

      History of dyspnea on mild exertion or chronic frequent productive cough; and

   2. 2. 

      Persistent or recurrent abnormal breath sounds, bilateral rales or rhonchi; and

   3. 3. 

      Radiographic findings of extensive disease with hyperaeration and bilateral peribronchial infiltration.

TABLE I